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Date run 5/9/2003 11:03:21AM SAN JO*N COUNTY ENVIRONMENTAL HEAL' EPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5/9/2003 <br /> Record Selection Criteria: Facility ID FA0010987 <br /> Make changes/corrections in RED ink or penci <br /> INFORMATION CHANGE(date) G <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0008987 Case Number: H09106 New Owner ID <br /> Owner Name T f LL t�-I L pl,,s E �u�.7��f LLC <br /> Owner DBA M <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 916-444-9304 <br /> Mailing Address zo( <br /> S !�/�^�In <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010987 <br /> Facility Name ANDERSON TRUSS <br /> Location 2050 E LOUISE AVE <br /> LATHROP, CA 95330 <br /> Phone 209-858-5584 <br /> Mailing Address Lf 1.�46 (fl eul u q-, � <br /> 0r e)L'\ fin U <br /> Care of P -tL T (L G A,S} <br /> Location Code APN: <br /> BOS District 003- MOW,VICTOR SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017987 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name ANDERSON TRUSS (Circle One) <br /> Account Balance as of 5/9/2003: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO514483 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0513275 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0520589 Active Y N A I D <br /> 2390-ABOVEGROUND TANK(SPCC) PR0516363 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0510987 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / 1 <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$155.00= Amount Paid Date <br /> Payment Tye Check Number Received by <br /> REHS: Date /_ / C% Account out: _�� Date <br /> COMMENTS: <br /> \\P hs-ehsq I-nt\apps\Envisions\Reports\5021.rpt <br />